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June 28, 2021

Throwing injuries common during sports

IU Health Arnett Hospital

Throwing injuries common during sports

As our attention is drawn again to the baseball and softball diamonds where the success of a team is in part related to the skills as throwers. The throwing motion is the fasted documented human motion which can place great stress on several areas of the body. Despite these high stresses, the vast majority of throwing related injuries are not due to a single episode, but rather, are a result of weeks, months and often times years of repetitive use. The stories of throwing athlete injuries are numerous, but there are steps that can be taken to keep your athlete on the field and remain injury free.

Throwing injuries can be painful episodes that rob a thrower of some of their finite time to play high school sports, and in some cases, limit their ability to get to the next level. When severe, these injuries can require surgical correction.

To throw an object far or fast, the body harnesses the power produced by the largest muscles in the legs which it then channels along the body in a series of events called the Kinetic Chain. The end result of the Kinetic Chain is that force being delivered to the hand of the thrower. A healthy thrower is one in which attention is paid to each of the steps of the kinetic chain to help each part to accommodate to the stress of throwing.

Kinetic Chain

When throwing is the problem….

“The throwers body will make adaptations to the repetitive stresses that throwing produces. These can make the body stronger to help protect it from injury. Some adaptations, however, are a result of overload and can place an athlete at greater risk for injury. The most visible example of this type of maladaptation is the throwers shoulder., explains Peter Seymour, DO, Fellowship-Trained Sports Medicine Orthopedic Surgeon at IU Health Arnett. “ In some throwing athletes, the shoulder will be lower on the throwing side than on the non-throwing side. This change is a result of overloading of some of the muscles on the back and shoulder, from the act of slowing the arm during follow through. In this instance, the lower shoulder is a signal of some weakness that can predispose them to other problems. These maladaptation’s, when unaddressed, can lead to loss of performance and injury.”

Shoulder droop

Fig 2. You can see in this image of a right-handed thrower, how the right scapula (wing bone), marked by the black dots, is lower and farther from the midline than the left. This is a maladaptation from repetitive throwing and can predispose this athlete to injury.

Seymour offers some tips on how to stay healthy:

Strength. There are three key areas to focus on to strength.

  • The arm: this is the most frequently injured area of a thrower. Special attention can be paid to the muscled of the arm and shoulders with exercises like the “Thrower Ten.” This is a set of exercises that a thrower can do daily to help strengthen and protect their arm. (Google search: throwers ten, to find a full description and videos of these exercises)
  • The Core: this is how force generated by the legs makes it to the arms. A strong core cannot only help a throwers velocity, it can decrease their risk of back injury
  • The legs: While an infrequent location of injury of the throwing athlete, leg strength, or a deficit of it, is often compensated for by the core and arms to make up for what the legs didn’t produce, which can lead to overload and injury.


  • The stresses of repetitive throwing can lead to flexibility deficits of the shoulder, scapula, hips and legs which can expose the thrower to injury. Making sure that flexibility is a part of your daily exercise helps minimize the effects of this repetitive workload. Pay special attention to the legs, hip and shoulders.


  • Be mindful of the number of pitches throw, number of innings pitches.
  • Don’t throw through fatigue. Studies have shown 30-fold increase in injury when throwers continue to throw once they are fatigued.
  • Don’t throw through pain. Small sprains and strains are part of throwing. These typically heal with rest. When these small issues aren’t given time to heal is when they can become bigger problems.

Other Activities:

Now more than ever, competitive sports compel athletes to specialize. This can have the negative consequence of exposing an athlete to a single type of stress, in some cases, all year long. Participation in other sports allows a young athlete to strengthen other muscles and gives their throwing arm time to rest.

As always, be sure your coaches and trainers are aware if you are hurting or have an injury. Many throwing related injuries can be addressed without surgery, but timely care is paramount to prevent injuries from progressing into something more serious.

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